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Ruptured Achilles Tendon
The Achilles tendon is the large cord like
structure on the back of the leg just above the heel. It is the largest
tendon in the body and has a tremendous amount of force transmitted
through it during walking, running and jumping activities. The Achilles
tendon is prone to injury, including rupture during periods of
increased stress and activity. Common activities causing injury include
running, basketball, baseball, football, soccer, volleyball and tennis.
These activities require jumping and pushing forces that are possible
due to the strength of the calf musculature and the ability of the
Achilles tendon to endure this stress. Men from the ages of 30-50 are
the most commonly injured during weekend athletic activities. Anatomy The
Achilles tendon is the extension from the two large muscles in the calf
region, the gastrocnemius and the soleus. These two muscles combine to
form the Achilles tendon. The tendon forms in the lower one third of
the leg and extends to the back of the heel bone (calcaneus). When the
muscles of the calf contract this produces tension on the Achilles
tendon pulling on the back of heel causing the heel to rise and the
foot to point downward. It is during this motion that high-tension
force is transmitted through the Achilles tendon during pushing and
jumping activity. This high tension force can cause the Achilles tendon
to tear or rupture. This happens in 3 common locations. The most common
location for a tendon tear is within the tendon substance just above
the heel. The second and third most common locations are where the
Achilles tendon attaches into the heel bone and higher in the leg,
where the tendon begins. Symptoms and Diagnosis Patients
often describe a feeling of being kicked or hit with a baseball bat in
the back of the heel during athletic activity. They are unable to
continue the activity and have an extreme loss of strength with the
inability to effectively walk. On physical examination there is often a
defect that can be felt in the tendon just above the heel. A diagnosis
of an Achilles tendon rupture is commonly made on physical exam. A MRI may be ordered to confirm the suspicion of a tear or to determine the extent of the tear. Treatment Early
treatment is imperative for the best long-term outcome. Surgical repair
is the most common treatment producing the greatest return to function
and activity level. The goal of surgery is to realign the two ends of
the ruptured tendon to allow healing. There are multiple techniques to
accomplish this goal that will vary from surgeon to surgeon. Recovery
from this injury is usually very successful with return to full
function in approximately 6 months. Post operatively casting is
required with the use of crutches or other means to remain
non-weightbearing for 4-8 weeks. This is followed by a course of
physical therapy. Partial rupture may or may not require surgical
intervention depending on the extent of injury but cast immobilization
is a common requirement.
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